Provider Demographics
NPI:1851530752
Name:CLEMENTS, JEANNETTE SMITH (RD)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:SMITH
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-4414
Mailing Address - Country:US
Mailing Address - Phone:662-816-6349
Mailing Address - Fax:
Practice Address - Street 1:740 NOTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4414
Practice Address - Country:US
Practice Address - Phone:662-816-6349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD1035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512I710023Medicare PIN
MS302I717146Medicare PIN